Pain Management Communication from the Patient Perspective

In primary care, which is the term indicating medical treatment provided by local doctors or other health workers, rather than special treatment in a hospital, pain is the most commonly reported symptom and it is a leading cause of disability (Matthias et al., 2010). Any disorder can trigger persistent pain, from arthritis to cancer, spine problems to digestive disorders, injuries to surgery. Chronic pain, which is a pain that persists past normal healing time, can also be a disease in itself (Treede et al, 2015; Gupta, 2015). Pain management discussions between patient and healthcare provider can be a difficult and frustrating experience. Because of the complexity, emotional influence and sensitivity of pain management, such discussions require a high degree of skill (Haverfield et al, 2018). Primary care providers described numerous relational difficulties when caring for patients with pain. Stress and burnout, in turn, can compromise effective patient care, draining primary care provider’s energy and reducing their capacity to show empathy to patients (Matthias et al., 2010).

While healthcare providers report difficulty in trusting patients’ pain reports, patients may feel providers are not listening to their concerns. Although this disconnect is well documented, less is known about the communicative features of discussions that patients perceive as helpful or hurtful to good pain care (Haverfield et al, 2018). Awareness of this issue is very important because communication with patients is therapeutic and has even been shown to be as effective as medications in the management of chronic pain (Gupta, 2015). Being responsive and empathetic helps both the physician and the patient handle the condition positively. These skills allow the physician to understand the patient’s point of view and incorporate it into the treatment (Gupta, 2015).

The concepts of patient-centered communication and patient participation are central to current views of the ideal physician–patient relationship (Cegala et al., 2009). Traditional practice with a provider-centered focus of delivery meant patients received care without regard to their preferences (Robinson et al., 2008). Instead, patient-centered care communication underscores engagement of patients in decision-making, consideration of patients’ emotions, keeping patients informed, and motivating patient self-management. These approaches promote better patient-provider communication and improve patient outcomes including medication adherence and satisfaction (Haverfield et al., 2018). However, some factors like the growing demand of clinical productivity, increasing paperwork, and electronic medical records may hamper an effective patient-physician communication, which is particularly challenging in the case of patients with chronic pain (Gupta, 2015).

Extensive research has focused on communication, particularly patient-centered communication. Provider styles that are based on using open-ended questions, paying attention to patient concerns, and giving patients the time to express themselves are considered patient-centered. Shared decision-making enables the provider to identify barriers to adherence and to offer solutions that account for the patient perspective (Robinson et al, 2018). The components of communication behavior that facilitate or hinder effective patient-centered care are less understood. Given that the patients’ preferences for communication are key to understanding how providers might improve interactions, a study was recently conducted to explore patients’ perspectives of patient-centered care communication within the context of pain management discussions. A team of Stanford University researchers conducted semi-structured interviews with patients regarding their experiences with pain assessment and management. Eight themes of patient-centered care communication emerged (Haverfield et al., 2018).

Judgment

Patients appreciate when a provider avoided judgments during discussions of pain. When perceiving no judgment from providers, patients feel more comfortable interacting with the provider.

Openness

Patients report that it is their responsibility to be open with the provider. By being forthcoming, patients feel this would aid in effective pain management.

Listening

Provider communication behaviors that contribute to perceptions of listening include acting on the pain information that was given, sharing additional information, asking follow-up questions, and taking the time to ensure an accurate understanding of the patient’s experience with pain.
Trust

Patients feel trust is crucial to discussions of pain and adherence to providers’ pain management recommendations.

Preferences

Though some patients prefer to have their provider make all pain management decisions, many expect and appreciate a dialog about pain management options.

Solution-Oriented

Providers perceive as being solution-oriented presented patients with multiple avenues for managing pain that were customized to the needs and wants of the individual patient.

Customization

Patients appreciate providers who go beyond the physical pain and consider mental health. Patients report that severe chronic pain could exacerbate or lead to feelings of depression.

Longevity

It is both a product of and a contributor to effective patient-centered care communication.

Table - Themes of patient-center communication within the context of pain management discussions. (Modified from Haverfield et al., 2018).

However, patient’s participation has an important impact on physician’s patient-centered communication. Patients who actively participate in medical interviews influence physicians to adopt a more patient-centered style of communication (Cegala et al., 2009). In any case, only multiple interactions over time can generate a constructive level of intimacy between patients and providers. Due to the complexity of pain, this reciprocal exchange is particularly relevant to pain management (Haverfield et al, 2018).


References

  • Cegala DJ, Post DM. The impact of patients' participation on physicians' patient-centered communication. Patient Educ Couns, 2009;77(2):202–208.
  • Gupta A. The importance of good communication in treating patients' pain. AMA J Ethics, 2015;17(3):265–267.
    Haverfield MC, Giannitrapani K, Timko C, Lorenz K. Patient-Centered Pain Management Communication from the Patient Perspective. J Gen Intern Med, 2018;33(8):1374–1380.
  • Matthias MS, Parpart AL, Nyland KA, et al. The patient-provider relationship in chronic pain care: providers' perspectives. Pain Med, 2010;11(11):1688–1697.
  • Robinson JH, Callister LC, Berry JA, Dearing KA. Patient-centered care and adherence: definitions and applications to improve outcomes. J Am Acad Nurse Pract, 2008;20(12):600–607.
  • Rolf-Detlef Treede, Winfried Rief, Antonia Barke, Qasim Aziz, Michael I. Bennett, Rafael Benoliel, Milton Cohen, Stefan Evers, Nanna B. Finnerup, Michael B. First, Maria Adele Giamberardino, Stein Kaasa, Eva Kosek, Patricia Lavand'homme, Michael Nicholas, Serge Perrot, Joachim Scholz, Stephan Schug, Blair H. Smith, Peter Svensson, Johan W.S. Vlaeyen, and Shuu-Jiun Wang. A classification of chronic pain for ICD-11. Pain. 2015 Jun; 156(6): 1003–1007.